Statins are among the most widely prescribed medications in the world. They are commonly prescribed to people who have high levels of unhealthy low-density lipoprotein (LDL) cholesterol in their bloodstream. High cholesterol can contribute to plaque formation in the arteries, which narrows the blood vessels and restricts blood flow. Blocked arteries can lead to strokes, heart attacks, and other circulation problems.
Statins may also be prescribed to lower your risk of cardiovascular disease. If you already have cardiovascular disease, statins may help your condition from getting worse. Statins may also help increase the levels of healthy high-density lipoprotein (HDL) in the blood. Additionally, they may help improve the health of the inside walls of your arteries.
Statins are taken every day, even after you get your cholesterol numbers to healthy levels. Statins are generally well tolerated. That means that many people take them with no noticeable side effects. Some people, however, do experience side effects.
The most common side effect is muscle pain. Severe muscle pain and other symptoms can often be eased by lowering the dose of your statin or by taking another type of statin. There is also a very small increased risk of developing diabetes while taking statins. All statins may cause some temporary flushing of the skin.
There are currently six types of statins approved by the U.S. Food and Drug Administration (FDA). Each drug works a little differently in the body. They mainly function by blocking an enzyme in the liver that’s responsible for making cholesterol. Everyone should have liver function tests before starting a statin. These drugs are processed in your liver, and the dose is based on your liver function.
Here’s a list of statins available in the United States, including their generic and brand names.
Lovastatin (Mevacor, Altoprev)
Lovastatin is considered to be one of the moderate-intensity statins. A maximum dose may lower your LDL cholesterol between 30 and 50 percent. It was the first statin to be approved by the FDA and has been on the market since 1987.
Lovastatin generally has fewer side effects than other, stronger statins. Potential side effects include:
- muscle pain
- digestive problems
- increased risks of diabetes
- “fuzzy” thinking
Taking lovastatin at dinner can sometimes ease digestive discomfort.
Simvastatin is another moderate-intensity statin and is more powerful than lovastatin. Simvastatin is used for medium-intensity therapy. Moderate doses of simvastatin may help lower LDL cholesterol by 30 to 50 percent.
When taken at high doses, simvastatin may be more likely to cause muscle pain than other statins taken at strong doses. It’s also associated with a higher risk of negative drug interactions.
A combination product, Simcor, has both simvastatin and niacin. Niacin is sometimes given to improve HDL levels, but it can interact with simvastatin. This combination may increase your risk of flushing.
Pravastatin is similar in its effects to lovastatin; it is also another moderate-intensity statin. It’s usually recommended for people who don’t need a dramatic reduction in their LDL cholesterol levels.
People taking pravastatin report fewer muscle aches and other common statin-related side effects. It’s generally well tolerated over a long period of time.
Atorvastatin is one of the most popular types of statins. It can be prescribed in moderate or high doses. Atorvastatin has been found to be more effective at lowering LDL cholesterol when compared to fluvastatin, lovastatin, pravastatin, and simvastatin. Atorvastatin was also the most effective at helping people who already had coronary heart disease reach healthy LDL goals.
When aggressive atorvastatin therapy (80 mg daily) was compared to moderate-dose pravastatin therapy (40 milligrams daily), people taking atorvastatin had significantly lower cardiovascular risks.
High doses of atorvastatin are associated with greater risk of side effects. Most new patients aren’t given high doses of atorvastatin at first. If you’ve taken high doses of atorvastatin for years without problems, maintain your regular appointments and be sure to tell your doctor about any new possible side effects. If you’re are having complications, your doctor may lower your dose or switch you to a different statin.
Fluvastatin is one of the mildest statin options. In head-to-head comparisons, fluvastatin was the least effective at helping people with coronary heart disease reach their LDL goals. A separate study, however, found that the risk of muscular problems was much lower with fluvastatin than with high doses of any other statin.
Milder statins, such as fluvastatin, are ideal for people who don’t yet have high LDL cholesterol and heart disease. The medication is usually prescribed for someone who only needs a mild cholesterol reduction. It’s also an alternative for people who have had muscle pain when taking other, stronger statins.
Rosuvastatin is the strongest statin on the market. Doses as low as 20 mg per day may lower LDL cholesterol levels by more than 50 percent. However, this medication does have the highest rates of side effect complaints. A lower dose may help to reduce or eliminate uncomfortable side effects.
Studies have found that rosuvastatin is generally safe and effective when taken at high doses. Rosuvastatin has also been found to be similarly effective as atorvastatin at reversing plaque buildup in the arteries of the heart.
All statins have the potential to interact with other medications. These interactions can increase your risk of side effects, including muscle pain. Severe muscle pain can be a sign of rhabdomyolysis.
Older drugs like lovastatin (Mevacor, Altoprev), simvastatin (Zocor), and atorvastatin (Lipitor) have the most drug interactions. They may interact with:
- antibiotics, like erythromycin (Ilotycin, Ery-Ped, Ery-tab)
- antifungal drugs, like ketoconazole (Xolegel, Extina, Nizoral)
- HIV drugs, like protease inhibitors
Some drugs for heart disease can also cause interactions, including:
- amiodarone (Cordarone, Pacerone)
- diltiazem (Cardizem, Dilt-cd)
- verapamil (Calan, Verelan)
- niacin (Niaspan)
These drugs also interact with grapefruit juice, so talk to your doctor before including that in your diet.
Newer drugs, like pitavastatin (Livalo), rosuvastatin (Crestor), and pravastatin (Pravachol), may have fewer drug interactions, but they can still interact with some of the same drugs. These include niacin, erythromycin, and some drugs used to treat infections.
To avoid drug interactions, talk to your doctor and pharmacist about all medications (both prescription and over the counter drugs) you’re taking before taking a statin.
Controlling your cholesterol can help lower your risk of heart disease. If you want to learn more about statins or other medications used to treat high cholesterol, discuss your options with your doctor. You should also speak with your doctor if you’re already taking a statin and are experiencing side effects or aren’t getting your LDL levels to a healthy range.
Taking a statin isn’t a cure-all for high cholesterol. A heart-healthy diet and regular exercise may also help control your cholesterol levels.